Healthcare Provider Details

I. General information

NPI: 1942783477
Provider Name (Legal Business Name): AUSTINA MERCY NJOKU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3061 STAGLIN DR
POWDER SPRINGS GA
30127-5081
US

IV. Provider business mailing address

3061 STAGLIN DR
POWDER SPRINGS GA
30127-5081
US

V. Phone/Fax

Practice location:
  • Phone: 404-444-7502
  • Fax:
Mailing address:
  • Phone: 404-444-7502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN241459
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: